On the morning of Nov. 2, 2012, Elle Korolis lay in a hospital bed, 39-weeks pregnant and waiting to deliver a baby girl whose heart was no longer beating.

After conducting an ultrasound that morning, her doctor told her that her baby didn’t have a heartbeat. Doctors were both kind and patient, but Korolis, now 41, recalls that their explanations and instructions felt clinical and cold. Even advice to seek grief counseling seemed more perfunctory than sympathetic. Fifteen hours later, still unable to fully process the information given to her, she delivered her stillborn daughter, Samantha Eleni Korolis, and plunged immediately into mourning.

This was not Korolis’s first encounter with pregnancy loss, nor would it be her last. She had one miscarriage before that and has had three since. She is far from alone in her heartache. Ten to 20 percent of all pregnancies end in miscarriage or loss. According to data from the Centers for Disease Control, there were about 1 million miscarriages—which is defined as loss of a fetus within the first 20 weeks of pregnancy—in 2010 alone. These losses, and those that occur later in pregnancy, can leave women and families profoundly distressed, vulnerable and uncertain about being able to fulfill their dreams of having a baby.

After returning from her honeymoon in 2004, Korolis paid a visit to her gynecologist for a normal check-up. She was shocked to learn she was pregnant, and excited to start a family.

While still in her first trimester, Korolis felt some sort of change. “Whatever it was that I felt inside of me, I didn’t feel it anymore,” Korolis tells SELF. When she visited the doctor again, she was told that she was going to have a miscarriage. “They don’t consider anything to be wrong with you,” she says. “They make it seem like it’s totally common, and it’s just your body’s way of gearing up for a healthy pregnancy.”

Korolis was inclined to believe what they told her. A few months later, she got pregnant again. She had a full and healthy pregnancy, giving birth to her son Nicholas, now 10. A year and a half later, she was pregnant again and gave birth to another healthy baby boy, Andrew, now 8.

It was nearly five years later that the then 37-year-old mother of two found out she was pregnant for a fourth time, with Samantha. After going into labor, the umbilical cord pinched unpredictably, cutting off the baby girl’s vital supply of blood and nutrients and making it impossible for her to survive.

Through her tears, Korolis recounts her delivery in the present tense, as if she is reliving the tragic day: “From the point of the doctor telling me that she no longer has a heartbeat, it feels surreal. It doesn’t seem like that kind of thing exists. The doctors understand what they’re telling you, but you don’t want to believe it. There’s a baby in you, and you’re preparing to give birth.”

When Samantha, 7 lb. 1 oz., was born, the room was silent. “It’s extremely isolating as a woman, legs spread open on a table giving birth to a dead baby. The baby comes out and just stays there because the doctor has to figure out what happened. The baby is just there, and it’s just kind of quiet,” Korolis describes.

Miscarriage can be an amazingly difficult thing to talk about. Not only does it represent a profound and heart-wrenching loss, but women are often met with an astonishing lack of empathy from doctors, family, and friends.

Dionne Martinez, 56, experienced two early miscarriages in the late 1990s. “I was 38 years old and had been married six years. I got pregnant right away, but I had a miscarriage at six weeks,” Martinez recalls.

The doctors told her that there was nothing they could do about it; miscarriage was not uncommon at her age. Friends and family tried to console her using common dictums like “It’s God’s will,” “It happens to a lot of people,” “It’s nature’s way of taking care of it,” and even “At your age, you can’t be that surprised.”

But when she tried to discuss her feelings, she was met with confusion and a surprising lack of sympathy from even her closest family members, like her mother, sisters, and husband. “No one wanted to hear me talk about it. A month later, if I got emotional, no one quite understood why I was crying about it. It was lonely experience,” she says.

When she got pregnant again shortly after, Martinez was both ecstatic and fearful for another loss. She wanted to “relish and experience every moment [of the second pregnancy], no matter what.” While the doctors assured them that there was little likelihood of a second miscarriage, the couple was also told not to get attached to the pregnancy until the third month.

In the fourth month, she learned that her son had a fetal anomaly and was given the option to terminate through a procedure called dilation and curettage. The doctor would clear the fetal tissue from the uterus and abort the pregnancy before Martinez could miscarry. Shocked, Martinez and her husband hesitated to make a decision on the spot. The doctor, seeming unconcerned with his patient’s emotions, snapped at the couple and asked abruptly, “Is she getting the procedure done or isn’t she?”

Ultimately choosing to continue the pregnancy, she miscarried her son, Cashew, at 20 weeks. Martinez was given a pamphlet on grieving and ushered out of the hospital.

Because it’s so common, medical professionals tend to dismiss pregnancy loss, and friends and family members often fail to register its impact, says Dr. Janet Jaffe, co-founder and director of the Center for Reproductive Psychology in San Diego. “Women are told, ‘You're young, you'll have another' and 'Don't worry about it,'" she says. “But it's not just the loss of the pregnancy that's saddening. It’s the loss of the dream of having a family. It’s a compound loss, and I think it's one reason why it has such a profound effect on people.”

Even in cases of early miscarriage and especially after a woman's first miscarriage, the grief is very real. Jaffe provides psychological support to families who have experiences miscarriage or infant loss. She chose to specialize in this sector after her personal experiences with miscarriage. Like Martinez, Jaffe received little support or acknowledgement from family and friends after her miscarriages. "It was a silent, lonely loss," Jaffe said.

Mercedes Sayago, M.D., an ob/gyn at Newport Beach Women’s Wellness Center in Newport Beach, Calif., says telling her patients that they have miscarried or are expected to miscarry is one of the most difficult parts of her job. In addition to the emotional strain, there is the added pain of often not being able to pinpoint why it happens. Sayago, who is empathetic to her patients, having experienced a miscarriage herself, says, “We don’t always know what triggers it in the body.”

The causes of miscarriage vary and are often poorly understood, which makes the situation only more difficult to grasp.

Fetal, maternal and even paternal factors can lead to miscarriages. Ironically, in vitro fertilization (IVF) is another potential cause of chronic miscarriage. “We think the treatment we’re giving them to get pregnant is also what’s causing subchorionic hematomas,” Sayago said. These hematomas, or unhealthy amounts of blood in the uterus, can put a mother at risk for premature labor, miscarriage (pregnancy loss before 20 weeks) or stillbirth (loss after 20 weeks, the point at which a baby could have a chance of living outside the womb). But causes for many miscarriages go unexplained. And the earlier the miscarriage, the less equipped professionals are to understand what went wrong.

And though Harvey Goldberg, a retired Sacramento-based ob/gyn, says that some lifestyle choices, such as smoking, alcoholism, drug use, and lack of prenatal care, can also make women more susceptible to miscarrying, the bottom line is that there is often very little women can do to prevent miscarriage or stillbirth.

For Elle Korolis, making sure that her friends and family understood that her stillbirth was beyond anyone’s control was a priority. She realized this before giving birth, when her mother-in-law arrived at the hospital and demanded to know, “What did you do?” Korolis felt strongly that her friends and family “needed to know that neither mother nor baby did anything wrong," and two days after giving birth, she wrote a group email explaining what had happened. “I wanted to make sure everyone understood that there was nothing wrong with me or with the baby, because not everyone does.”

Communication problems among couples may also exacerbate women’s feelings of isolation after pregnancy loss, Jaffe says. While women are inclined to grieve through tears and talking, “men tend to grieve more privately. They will often do things more intensely, like work more and drink more [...] If women can understand the differences, then they can accept it more.”

It’s a sad paradigm that Martinez has witnessed in her own life, and in the lives of others. It wasn’t until she discovered the Sacramento support group Sharing Parents, through her genetic counselor, that she felt free to talk about her losses. She received consolation from other bereaved parents and eventually started helping other newly grieving couples by becoming a volunteer for the organization. Today, she continues to volunteer at the support group while raising her two adopted children.

In many cases, women often feel that their bodies have betrayed them, says Jaffe, who is the author of Unsung Lullabies, Understanding and Coping with Infertility. In her practice, she urges patience. “It really takes time, and that’s something that people don’t understand. They want to hurry up and just be parents.”

Jaffe reassures them that their story is far from over: “(It) didn’t begin as they wanted it to, and they’re in the middle of it when they come to me. It will have an end,” she says.

The Korolises are working on their next chapter. Two months after delivering Samantha, Elle was pregnant again. Despite being highly monitored, Korolis lost the baby at nine weeks. She became pregnant two more times, but each time miscarried again before the reaching the second trimester. Still, her fertility specialist found nothing physically wrong with Korolis. To this day there has been no explanation at all.

Korolis is currently pregnant and hopeful. She is due at the end of June.